Vision and hallucinations in older adults

项目摘要 幻视影响大约20%的阿尔茨海默病和50%的帕金森病 患者幻觉是患者和护理人员痛苦的主要来源，也是一种独立的风险 受伤、疗养院安置和死亡率的因素。因为治疗幻觉的方法 有限的，并有显着的不良影响的风险，预防幻觉将有一个变革性的 对患有神经退行性疾病的老年人的公共卫生影响。视力障碍是一个危险因素， 幻觉，而且由于在美国高达一半的视力丧失是可以预防或治疗的，因此预防和 眼科疾病的治疗可以预防或减轻老年人幻觉的严重程度。然而，在这方面， 缺乏对特定年龄相关眼病和幻觉结果的研究，限制了这些研究。 改善医疗保健。该提案要求支持为博士提供指导性职业发展奖。 阿里·哈梅达尼是宾夕法尼亚大学的神经病学训练的神经眼科学家和流行病学家。 这个项目的首要目标是了解视觉通路的结构，功能，疾病， 治疗会导致老年人产生幻觉在目标1中，Hamedani博士将分析纵向数据， 来自两项与医疗保险相关的国家健康调查（国家健康和老龄化趋势研究和健康和 退休研究），以确定年龄相关性黄斑变性，原发性开角型青光眼， 白内障手术与幻觉的发生率有关， 5，200名高风险老年人使用先进的生存分析和边缘结构模型来解释 时间依赖性混杂在目标2中，Hamedani博士将招募一个帕金森病前瞻性队列 开始使用药物治疗幻觉的患者，以确定低对比度敏锐度和视网膜 神经节细胞厚度与幻觉的严重程度和治疗反应有关。在执行这些 目标，Hamedani博士将获得眼科流行病学，视网膜成像， 在光学相干断层扫描和眼科临床专家的指导下， 调查（乔尔舒曼，医学博士）和神经退行性疾病流行病学和卫生服务研究 （Allison Willis，MSCI医学博士）。该项目的结果将提供有关视觉的基本知识， 系统在引起幻觉中的作用，并为未来的研究铺平道路，以测试视觉障碍， 眼科疾病作为老年人幻觉和其他神经认知结果的预防目标。 通过在这个职业发展奖期间获得的研究培训和指导经验，博士。 Hamedani将成为应用流行病学和结果的独立调查员 眼科学在衰老和神经退行性疾病中的研究。

PROJECT SUMMARY Visual hallucinations affect approximately 20% of Alzheimer disease and 50% of all Parkinson disease patients. Hallucinations are a leading source of patient and caregiver distress and are an independent risk factor for injury, nursing home placement, and mortality. Because treatment options for hallucinations are limited and have significant adverse effect risks, the prevention of hallucinations would have a transformative public health impact for older adults with neurodegenerative disease. Visual impairment is a risk factor for hallucinations, and since up to half of all vision loss in the U.S. is preventable or treatable, the prevention and treatment of ophthalmic disease could prevent or reduce the severity of hallucinations in older adults. However, studies of specific age-related eye diseases and hallucination outcomes are lacking, limiting these improvements in healthcare. This proposal requests support for a mentored career development award for Dr. Ali Hamedani, a neurology-trained neuro-ophthalmologist and epidemiologist at the University of Pennsylvania. The overarching goal of this project is to understand how visual pathway structure, function, diseases, and treatments contribute to hallucinations in older adults. In Aim 1, Dr. Hamedani will analyze longitudinal data from two Medicare-linked national health surveys (the National Health and Aging Trends Study and Health and Retirement Study) to determine whether age-related macular degeneration, primary open-angle glaucoma, and cataract surgery are associated with the incidence of hallucinations in a nationally representative sample of 5,200 high-risk older adults using advanced survival analysis with marginal structural models to account for time-dependent confounding. In Aim 2, Dr. Hamedani will recruit a prospective cohort of Parkinson disease patients who are beginning a medication for hallucinations to determine whether low-contrast acuity and retinal ganglion cell thickness are associated with hallucination severity and treatment response. In executing these aims, Dr. Hamedani will be obtain additional training in ophthalmic epidemiology, retinal imaging, and biostatistics under the mentorship of experts in optical coherence tomography and ophthalmic clinical investigation (Joel Schuman, MD) and neurodegenerative disease epidemiology and health services research (Allison Willis, MD MSCI). The results of this project will provide fundamental knowledge about the visual system’s role in causing hallucinations and pave the way for future studies to test visual impairment and ophthalmic disease as a prevention target for hallucinations and other neurocognitive outcomes in older adults. Through the research training and mentorship experience gained during this career development award, Dr. Hamedani will establish himself as an independent investigator in the applied epidemiology and outcomes research of ophthalmology in aging and neurodegenerative disease.